Antibiotics prescribed ‘blindly’, doctors admit

Cambodian physicians, by their own admission, routinely prescribe antibiotics “inappropriately” based on habit and poor hygiene rather than evidence of an infection, a new study has found.

The article, published by peer-reviewed science site BioMed Central last week, included research gleaned from focus group discussions with 103 Cambodian physicians, and revealed that “antibiotics prescribing occurred in the absence of microbiology evidence of infection”.

“Every day, doctors are not performing appropriately. We have made lots of mistakes with our antibiotic prescribing,” one doctor is quoted as saying in the report.

“Nowadays, we prescribe antibiotics blindly,” another added.

Worryingly, many doctors prescribed antibiotics “excessively” as a “preventative” measure, fearing poor hygiene in hospital rooms would result in an infection.

“I’m always afraid, because everything is not clean and the patients are not hygienic, so we give antibiotics right away,” one doctor admitted.

Further, many doctors had difficulty differentiating bacterial from viral infections – which cannot be cured by antibiotics – and a perception that patients demanded “stronger” or “quality” medicine led them to prescribe unnecessary antibiotics.

The data – collected over five months up until February 2014 – found that lengthy and unreliable tests, combined with a patient’s financial constraint, saw some physicians not using microbiology services, even when they were available.

But Dr Sok Srun, director of the department of hospital services at the Ministry of Health, denied the study’s findings and said Cambodian doctors “apply the rational use of medicine”.

“We are implementing monitoring, training and planning strategies in each referral hospital to reduce unnecessary prescription of medication, such as antibiotics, to improve patient safety,” he said. “Currently, we are updating the infection prevention and control guideline, [as] this guideline has been implemented since 2010.”

According to the World Health Organization (WHO), antibiotics have increasingly lost their effectiveness globally due to resistance, which could lead to more than 5 million deaths per year in the Asia Pacific region by 2050.

“Like other countries in the region, Cambodia is witnessing a growing threat of antimicrobial resistance, brought about by the excessive and irrational use of antibiotics at all levels of the food and livestock production, in the health care system and by the general public,” WHO spokesperson Vicky Houssiere said in a statement yesterday.

At the recent launch of the Antibiotic Awareness Week, WHO representative Dr Yungo Liu said the Kingdom had developed a policy and action plan to combat resistance, and called for “strict prescribing and dispensing practices”.

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